Male Reproductive Flashcards
Structures of the male genitalia
Penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles
Cremasteric muscles
Allows scrotum to relax or contract
Spermatogenesis requires a temperature of
37 degrees celsius
Controlled by altering distance of testes from body
Testicles
Produce spermatazoa and testosterone
Epididymis
Storage, maturation and transit of sperm
Prostate Gland
Produces major volume of ejaculatory fluid
Fibrinolysin liquefies coagulated semen for optimal sperm motility
Erection of penis
Two corpora cavernosa engorge with blood (20-50mL)
Arterial dilation and decreased venous outflow produce increased blood supply
Controlled by ANS and local synthesis of nitric oxide
Ejaculation involves
Vas deferens, epididymides, prostate and seminal vesicles
Orgasm is followed by constriction of blood vessels
Infants and Children
Sexual differentiation occurs at 12 weeks of gestation
Third trimester - testes descend
Adolescents
Onset of puberty - scrotal skin reddens, thins and becomes pendulous, hair appears on penis
Prostate gland enlarges
Older Adults
Pubic alopecia Scrotum more pendulous frequency of SA declines Erection develops more slowly Orgasm less intense
Genital Hair Distribution
Coarser then scalp hair
Inspection of Penis
Dorsal vein should be apparent
Circumscised or uncircumcised
Look for smegma if uncircumcised
Phimosis - foreskin is tight and cannot be retracted, result of balanitis (glans inflammation)
Circumcised pts will have glans exposed and erythematous and dry
Balanoposthitis
Inflammation of glans penis and prepuce occur in uncirumcised individuals either bacterial or fungal
More common in those c DM
Urethral Meatus
Orifice should appear slitlike and be located on the ventral surface
Opening should be glistening and pink
Erythema or discharge indicates inflammatory disease
Penile Shaft
Palpate for tenderness and induration
Presence of dischage may be STI
Should be free of nodules
Priapism - prolonged erection; can occur in those with leukemia, hemoglobinopathies (Sickle Cell) or as a result from medications for impotence
Scrotum
Reddened skin may be inflammatory process
Left testicle is usually larger due to longer spermatic cord
Thickness varies c temperature and age
Lumps = sebaceous cyst
Unusual thickening can be edema - does not imply genitalia problem, but cardiac or hepatic
Hernia
Pt stands and bears down
Inspect inguinal and fossa ovalis
Auscultate for BS is uncomplicated reducible hernia
Ask pt to cough, inguinal hernias will produce viscus against finger
Indirect hernias lie within the inguinal canal
Hernias can also come through external canal and even pass into the scrotum
Indirect hernias suggest bilateral herniation
If viscus is felt medial to external canal, usually represents direct inguinal hernia
Testes
Should be sensitive but not tender
Smooth, rubbery and free of nodules
Syphillis and DM neuropathy causes insensitivity to painful stimuli
Irregularities in texture indicate cyst, infection or tumor
Epididymis
Smooth, discrete, larger cephalad and nontender
Vas Deferens
Smooth and discrete
Should not be beaded or lumpy
Might indicate DM or TB
Cremasteric Reflex
Stoke inner thigh c blunt instrument and watch for rise of testicle and scrotum
Inspection of Infants
Inspect for size, placement of urethral meatus and anomalies
Length is 2-3cm
Transitory erection is common
Straight projection
Micropahllus - could be Klinefelter syndrome and may not be appropriate for circumcision
Hooked, downward bowing of penis suggests chordee
Differentiate microphallus from clitoris
Inspection and palpation of infants
Do not pull back foreskin too much if infant will not be circumscribed
Inspect for ulcerations, bleeding, an inflammation
Reduced force or caliber of urinary stream may indicate stenosis of urethral meatus
Inspect scrotum for size, shape, symmetry, rugae and presence of testicles
Premature infant will be lacking regaue and testes
Edema is common
Proximal end is larger
A deep cleft in scotum is associated c amibguous genitalia
Palpate testis of infants
Retractile testis have a risk of becoming an ascending or acquired undescended testis
Undescended testicle - palpable in inguinal canal but cannot be pushed into scrotum or not palpable at all
Palpate for hernias in infants
Palpate over inguinal canal with fingers to feel spermatic cord
If feeling of smoothness disappears as you palpate, indicative of invisible hernia
Apparent bulge = visible hernia
Different types of hernias in infants
Fluid, gas or solid material
Attempt to push the hernia back into external inguinal canal - if no change in size, most likely fluid (hydrocele)
A mass that does not transilluminate but does change in size is probably a hernia
A mass that neither changes in size or transilluminates may represent an incarcerated hernia or testicular cancer
Inspection and Palpation in Children
If penis is swollen or tender or if bruises are present, suspect SA
Well-formed rugae - indicate testes have descended during infancy
Use tailor position to detect inguinal hernias
Cryptorchidism - undescended testes
Hard, enlarged, painless testicle may indicate tumor
Acute swelling of the scrotum with discoloration could be torsion or orchitis
Acute painful swelling without discoloration and a a thickened epididymis = epididymitis
Enlarged penis without enlargement of testes = precocious puberty, adrenal hyperplasia and CNS lesions
Sexaul Maturation Rating (SMR)
SMRs for pubic hair and genitalia are closely correlated
Graded 1-5 (Based on changes in pubic hair, development of tests, scrotum and penis)
Correlates with physical maturity as measured by bone age compared with chronologic age
